IWATER, INC. (5) - Laserfiche WebLink

Home Browse Search

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC0403 03 C (Ed.07-18) ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE OFFICERS AND DIRECTORS COVERAGE/EXCLUSION-CALIFORNIA If the employer named in Item 1 of the Information Page is a quasi-public or private corporation,this policy applies to all officers and members of boards of directors while rendering actual service for the corporation for pay, as employees,except those excluded below who 1. individually own at least 10 percent of the corporations issued and outstanding stock,or 2. individually own at least 1 percent of the corporations issued and Outstanding stock if that officers or members parent, grandparent, sibling, spouse, or child awns at least 10 percent of the corporations issued and outstanding stock and that officer or membe r is covered by a health insu rance policy or a healthcare service plan,or 3. are officers or members of the board of directors of a cooperative corporation organized pursuant to the Cooperative Corporation Law(Corporations Code,Sections 12200.12704)whostate that he orshe is covered by both a health care service plan or health insurance policy, and a disability insurance policy that is comparable in scope and coverage,as determined by the Insurance Commissioner,to a workers compensation policy. If the employer named in Item 1 of the Information Page is a private corporation,ora private cooperative corporation organized pursuant to the Cooperative Corporation Law, this policy applies to an officer or director who is the sole shareholder of the corporation, as an employee,except if excluded below. The insurance under this policy is limited as follows:It is AGREED that,anything in this policy to the contrary notwithstanding,this policy DOES NOT INSURE: Officers,Directors and Trustees Excluded Title DONALD RHODES EXECUTIVE OFFICER JU LIE RHODES EXECUTIVE OFFICER Nothing in this endorsement shall be held to vary,alter,waive or extend any of the terms,conditions,agreements,or limitations of this policy other than as above stated. Nothing elsewhere in this policy shall be held to vary, alter,waive or limit the terms, conditions, agreements or limitationsin this endorsement. it is further agreed that remuneration when used as a premium basis forsuch insurance as is afforded by this policy shall not include the remuneration of any person excluded from coverage in accordance with the foregoing. FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 37001S A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF WORK STOP ORDER,LARGE FINES,AND OTHER SUBSTANTIAL PENALTIES(Labor Code Sectlon 3710.1,etseq.). This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below Is required only when this endorsement is Issued subsequent to preparation ofthe policy.) Endorsement Effective Policy No. Endorsement No. Insured Insurance Company 6� Countersigned by WC 0403 03 C Page 1 of 1 (Ed.7-18) 9)2017 by the Workers Compensation Insurance Rating Bureau or California.All rights reserved. 93-6413